Current approaches to medical care optimization for patients with multimorbidity


  • D.D. Diachuk State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine”, State Administrative Department, Verchnia str., 5, Kyiv, 01014, Ukraine
  • I.M. Hidzynska State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine” , State Administrative Department, Verchnia str., 5, Kyiv, 01014, Ukraine
  • G.Z. Moroz State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine”, State Administrative Department, Verchnia str., 5, Kyiv, 01014; Ukrainian Military Medical Academy, Moskovska str., 45/1, Kyiv, 01015, Ukraine
  • I.M. Tkachuk Ukrainian Military Medical Academy, Moskovska str., 45/1, Kyiv, 01015, Ukraine



multimorbidity, patient-centered care, guidelines


Scientific interest to the problem of multimorbidity is increasing due to the increase of the number of such patients. The aim of this work  was to analyze and summarize current approaches to optimizing care for patients with multimorbidity and the results of their implementation in clinical practice. Since the beginning of this century, a number of documents have been created by WHO, government agencies and professional medical societies to improve medical care to patients with multimorbidity. The evidential basis of the effectiveness of the majority of the proposed measures based primarily on expert consensus. In 2016 NICE has published a clinical guideline NG56 «Multimorbidity: clinical assessment and management», WHO – a monograph  «Multimorbidity: Technical Series on Safer Primary Care». In 2017 NICE has published a quality standard – Quality Standard №153 «Multimorbidity». The strategy of improvement of medical care for patients with multimorbidity is directly related to the patient-centered approach formation, which includes comprehensive assessment of the patient's condition. The main component of medical care is the definition of a realistic goal of medical intervention according to patient`s preferences, and making the choice of the optimal amount of diagnostic, treatment, and preventive measures, which can lead to the desired goal. A number of studies (the 3D randomized controlled trial, the MultiCare AGENDA, the SPPiRE study, the WestGem study etc.) have being conducted to evaluate the effectiveness of implementing proposed approaches in clinical practice. The results of the studies and meta-analysis do not provide conclusive evidence of the medical and economic effectiveness of their implementation at the presentstage. Improving the outcomes of medical care to patients with multimorbidity involves conducting further clinical trials that can provide evidence to determine the list of most effective interventions for clinical practice.


Salisbury C, Man M-S, Chaplin K, Mann C, Bo­wer P, Brookes S, et al. A patient-centred intervention to improve the management of multimorbidity in general practice: the 3D RCT. Health Services and Delivery Research. 2019;7(5). doi:

Coulter A, Kramer G, Warren T and Salisbury C. Building the House of Care for people with long-term conditions: the foundation of the House of Care framework. British Journal of General Practice. 2016;66(645):e288-e290. doi:

Millar E, Dowell A, Lawrenson R, Mangin D, Sa­rfati D. Clinical guidelines: what happens when people have multiple conditions? The New Zealand Medical Journal [Internet]. 2018;131(1472):73-81. Available from:

Muche-Borowski C, Lühmann D, Schäfer I, Mundt R, Wagner H-O, Scherer M. Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology. BMJ Open. 2017;7:e015478. doi:

Muth C, Harder S, Uhlmann L, Rochon J, Fuller­ton B, Güthlin C, et al. Effectiveness of a complex inter­vention on Prioritising Multimedication in Multimorbidity (PRIMUM) inprimarycare: resultsof a pragmatic cluster randomised controlledtrial. BMJ Open. 2018;8(2):e017740. doi:

Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: oppor­tunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Services Research. 2015;15:194. doi:

Kastner M, Cardoso R, Lai Y, Treister V, Ha-mid JS, Hayden L, et al. Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and metaanalysis. CMAJ. 2018;190(34):e1004-12. doi:

Verdoorn S, Kwint HF, Blom JW, Gussekloo J, Bouvy ML. Effects of a clinical medication review focu-sed on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study). PLoS Medicine. 2019;16(5):e1002798. doi:

Millar E, Stanley J, Gurney J, Stairmand J, Da-vies C, Semper K, et al. Effect of multimorbidity on health service utilisation and health care experiences Journal of Primary Health Care. 2018;10(1):44-53. doi:

Dzau VJ, Inouye SK, Rowe JW, Finkelman E, Yamada T. Enabling Healthful Aging for All – The National Academy of Medicine Grand Challenge in Healthy Longevity. NEJM. 2019;381(18):1699-701. doi:

Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Journal of the American Geriatrics Society. 2012;60(10):e1-е25. doi:

Halpern S.D. Goal-Concordant Care – Searching for the Holy Grail. NEJM. 2019;381(17):1603-6. doi:

Köberlein-Neu J, Mennemann H, Hamacher S, Wal-tering I, Jaehde U, Schaffert C, Rose O. Interprofessional medication management in patients with multiple morbi-dities – a cluster-randomized trial (the WestGem study). Deutsches Arzteblatt International. 2016;113(44):741-8. doi:

Smith SM, Wallace E, O'Dowd T, Fortin M. Inter-ventions for improving outcomes in patients with multimor-bidity in primary care and community settings. The Cochra-ne Database of Systematic Reviews. 2016;14(3):CD006560. doi:

Kernick D, Chew-Graham C. A, O’Flynn N. Cli­nical assessment and management of multimorbidity: NICE guideline. The British journal of general practice: the journal of the Royal College of General Practitioners. British Journal of General Practice. 2017;67(658):235-6. doi:

Multimorbidity: a priority for global health re­search. The Academy of Medical Sciences. [Internet]; 2018. Available from:

Multimorbidity: clinical assessment and mana­gement. Institute for Health and Care Excellence: NG56. London; 2016.

Multimorbidity: Quality Standard. National Institute for Health and Care Excellence: QS153. [Internet]; 2017. Available from:

Multimorbidity: Technical Series on Safer Primary Care. Geneva; World Health Organization. [Internet]; 2016 Available from:

Navickas R, Petric VK, Feigl AB, Seychell M. Multimorbidity: what do we know? What should we do? Journal of Comorbidity. 2016;6(1):4-11. doi:

Multiple Chronic Conditions – A Strategic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions / U.S. Department of Health and Human Services. Washington, DC, 2010. Available from:

Schäfer I, Kaduszkiewicz H, Mellert C, Löffler C, Mortsiefer A, Ernst A, et al. Narrative medicine-based intervention in primary care to reduce polypharmacy: results from the cluster-randomised controlled trial MultiCare AGENDA. BMJ Open. 2018;8(1):e017653.

Zemedikun DT, Gray LJ, Khunti K, Davies MJ, Dhalwani NN. Patterns of multimorbidity in middle-aged and older adults: an analysis of the UK Biobank data. Mayo Clinic Proceeding. 2018;93(7):857-66. doi:

Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalized care planning for adults with chronic or long‐term health conditions. The Cochrane Database of Systematic Reviews. 2015;3. doi:

Kingston A, Robinson L, Booth H, Knapp M, Jag-ger C. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Agein-gand Care Simulation (PACSim) model. Age and Ageing. 2018;47(3):374-80. doi:

McCarthy C, Clyne B, Corrigan D, Boland F, Wallace E, Moriarty F, et al. Supporting prescribing in older people with multimorbidity and significant poly-pharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot. Implementation Science. 2017;12:99. doi:

Muth C, van den Akker, M, Blom J, Mallen CD, Rochon J, Schellevis FG, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Medicine. 2014;12:223. doi:

Valdivieso B, García-Sempere A, Sanfélix-Gi­meno G, Faubel R, Librero J, Soriano E, Peiró S. The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic con­ditions. A prospective study. Medicina clinica. 2018;151(8):308‐14. doi:

Hasanpoor E, Hallajzadeh J, Siraneh Y, Hasan-zadeh E, Haghgoshayie E. Using the Methodology of Systematic Review of Reviews for Evidence-Based Medicine. Ethiop J Health Sci. 2019;29(6):775-8. doi:

Dzau VJ, McClellan MB, McGinnis JM, Burke SP, Coye MJ, Diaz А, et al. Vital directions for health and health care: priorities from a National Academy of Medicine in itiative. JAMA. 2017;317(14):1461-70. doi:

Poitras M-E, Maltais M-E, Bestard-Denommé L, Stewart M, Fortin M. What are the effective elements in patient-centered and multimorbidity care? A scoping review. BMC Health Services Research. 2018;18:446. doi:




How to Cite

Diachuk D, Hidzynska I, Moroz G, Tkachuk I. Current approaches to medical care optimization for patients with multimorbidity. Med. perspekt. [Internet]. 2020Dec.28 [cited 2023Dec.4];25(4):4-11. Available from: